Chinese herbal medicines revisited: a Hong Kong perspective

doi:10.1016/S0140-6736(05)80091-1

The Lancet

Volume 342, Issues 8886–8887, 18–25 December 1993, Pages 1532-1534

https://doi.org/10.1016/S0140-6736(05)80091-1 Get rights and content

Summary

Chinese herbal medicines (CHM) and Chinese proprietary medicines (CPM) are widely used by people of Chinese origin throughout the world. Although the use of these medicinal materials rarely causes significant toxic effects, cases of severe and even fatal poisoning have occurred after medication with herbs containing aconitine, podophyllin, and anticholinergic substances. Furthermore, CHM and CPM are often adulterated with substituted herbs, heavy metals, and western medicines; such contamination can have important clinical consequences. In Hong Kong, surveillance and legislation are required to control the use of some of these herbal preparations. In other countries, medical practitioners should also be aware of the possibility that these herbal-medicine-related remedies may cause significant clinical problems in their Chinese patients.

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Investigating the interactions of benzoylaconine and benzoylhypacoitine with human serum albumin: Experimental studies and computer calculations
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Benzoylaconine (BAC) and benzoylhypacoitine (BHA), which are derived from Aconitine (AC) and hypacoitine (HA), are commonly used in Traditional Chinese Medicine (TCM). The pharmacokinetics of drugs can be affected by their binding to proteins. Therefore, it is necessary to investigate drug-protein interactions. In this study, multi-spectroscopic, molecular docking and dynamics simulation were applied to investigate the interaction mechanisms of human serum albumin (HSA) with BAC/BHA. The binding constants (K_a) of the HSA-BAC/BHA systems at 298 K were 1.70 × 10⁵ and 1.88 × 10⁵ M⁻¹, respectively. Stable HSA-BAC/BHA complexes were formed under the static quenching mode. Hydrogen bonds and van der Waals forces are the main driving forces during the spontaneous process, and BAC/BHA were suggested embedding into the site I of HSA. Circular dichroism (CD) spectroscopy revealed a reduction of 1.9% and 1.4% in the α-helical structure content of HSA induced by BAC/BHA. The molecular docking found that the electronic structure domains of the nitrogen and benzene ring skeletons were critical in the complex formation. Furthermore, computer simulations provided insights into the stability changes and illustrated that the residues such as TRP-214, LEU-219, and LEU-238 acted as key residues in the binding process between aconitine analogs and HSA.
Determination of heavy metals in edible vegetables and a human health risk assessment
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Vegetable consumption is a significant route to elevate the concentrations of potentially toxic heavy metals to be mobilized and enter the food chain. Therefore, the purpose of this research was to determine the number of heavy metals such as As, Cd, Cr, Co, Cu, Ni and Pb in daily consumed legume collected in the Erbil city and to determine their health risks relevant to their estimated daily intake and Hazard Quotient. Total contents of As, Cd, Cr, Co, Cu, Ni and Pb in Artemisia dracunculus L. (tarragon), Laurus nobilis L. (bay laurel), Anethum graveolens L.(dill), Prosopis farcta J.F.Macbr (Syrian mesquite), Vitis vinifera L.(vine leaves), Thymus sp. (thymes), Eruca sativa Mill. (arugula), Ocimum basilicum L. (basil), Portulaca oleracea L.(common purslane) and Petroselinum crispum Fuss (parsley) were measured subsequent microwave-assisted acid digestion utilizing nitric acid/ hydrogen peroxide followed by analysis using ICP-MS. A certified reference material (GBW10015-spinach) was analyzed to validate the applied methodology.
The outcome of this work revealed that the range of heavy metals, including As, Cd, Cr, Co, Cu, Ni and Pb in vegetables based on dry weight (µg/g) were 0.15–0.63, 0.110–0.612, 0.45–1.76, 0.10–0.32, 0.64–1.92, 0.29–1.27 and 0.61–1.65, respectively. Hazard quotient of As, Cd, Cr, Co, Cu, Ni and Pb were in the range of 2.71–11.38, 0.60–3.32, 0.81–3.18, 0.03–0.09, 0.09–0.26, 0.08–0.34 and 0.83–2.23 respectively. The findings of this study revealed that there would be a noncarcinogenic health risk to the population of Erbil city because the Hazard Quotient value is higher than 1 for As (in all analyzed vegetables), Cd (in all vegetables except dill, Syrian mesquite, thymes, arugula, basil and common purslane) and Cr (in all vegetables except vine leaves, common purslane and parsley).
Neoline, fuziline, songorine and 10-OH mesaconitine are potential quality markers of Fuzi: In vitro and in vivo explorations as well as pharmacokinetics, efficacy and toxicity evaluations
2023, Journal of Ethnopharmacology
Fuzi, the lateral roots of Aconitum carmichaelii Debx, plays an irreplaceable role in treating Yang deficiency and cold coagulation syndromes. However, Fuzi has a narrow margin of safety since its pharmacological constituents, Aconitum alkaloids, have potential cardiotoxicity and neurotoxicity. The current quality markers (Q-markers) for the control of Fuzi's efficacy and toxicity are 3 monoester-diterpenoid alkaloids, namely, benzoylaconine (BAC), benzoylhypaconine and benzoylmesaconine (BMA) and 3 diester-diterpenoid alkaloids, namely, aconitine (AC), hypaconitine and mesaconitine (MA). However, mounting evidence indicates that the current 6 Q-markers may not be efficacy- or toxicity-specific enough for Fuzi.
The aim of this study was to explore and evaluate efficacy- or toxicity-specific potential quality markers (PQ-markers) of Fuzi.
PQ-markers were explored by analyzing 30 medicinal samples and alkaloids exposed in mouse. Pharmacokinetics of PQ-markers on C57BL/6J mice were determined. Anti-inflammatory effects of PQ-markers were evaluated by λ-carrageenan-induced paw edema model and lipopolysaccharide-induced RAW264.7 cell inflammatory model, while analgesic effects were assessed by acetic acid-induced pain model and Hargreaves test. Cardiotoxicity and neurotoxicity of PQ-markers were assessed by histological and biochemical analyses, while acute toxicity was evaluated by modified Kirschner method.
After in vitro and in vivo explorations, 7 PQ-markers, namely, neoline (NE), fuziline (FE), songorine (SE), 10-OH mesaconitine (10-OH MA), talatizamine, isotalatizidine and 16β-OH cardiopetalline, were found. In the herbal medicines, NE, FE, SE and 10-OH MA were found in greater abundance than many other alkaloids. Specifically, the amounts of NE, FE and SE in the Fuzi samples were all far higher than that of BAC, and the contents of 10-OH MA in 56.67% of the samples were higher than that of AC. In mouse plasma and tissues, NE, FE, SE, talatizamine, isotalatizidine and 16β-OH cardiopetalline had higher contents than the other alkaloids, including the 6 current Q-markers. The pharmacokinetics, efficacy and toxicity of NE, FE, SE and 10-OH MA were further evaluated. The average oral bioavailabilities of NE (63.82%), FE (18.14%) and SE (49.51%) were higher than that of BMA (3.05%). Additionally, NE, FE and SE produced dose-dependent anti-inflammatory and analgesic effects, and their actions were greater than those of BMA. Concurrently, the toxicities of NE, FE and SE were lower than those of BMA, since no cardiotoxicity or neurotoxicity was found in mice after NE, FE and SE treatment, while BMA treatment notably increased the creatine kinase activity and matrix metalloproteinase 9 level in mice. The average oral bioavailability of 10-OH MA (7.02%) was higher than that of MA (1.88%). The median lethal dose (LD₅₀) of 10-OH MA in mice (0.11 mg/kg) after intravenous injection was close to that of MA (0.13 mg/kg). Moreover, 10-OH MA produced significant cardiotoxicity and neurotoxicity, and notable anti-inflammatory and analgesic effects that were comparable to those of MA.
Seven PQ-markers of Fuzi were found after in vitro and in vivo explorations. Among them, NE, FE and SE were found to be more efficacy-specific than BMA, and 10-OH MA was as toxicity-specific as MA.
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Asthma can be complex and difficult to manage. Patients often seek alternative treatment options, including Traditional Chinese Medicine (TCM). The paradigms that inform TCM treatments include a philosophy focusing on modifying the whole body status (‘bian zheng’) to treat the lungs. TCM practitioners use personalized treatment plans based on clusters of clinical patterns (eg. cold-related wheezing, kidney insufficiency/energy-deficiency-related wheezing). TCM includes herbal remedies and non-oral therapies such as cupping, acupuncture, and massage. The efficacy of TCM treatments of asthma is not well described as the majority of studies are published only in Chinese literature. We reviewed all available clinical trials in CNKI, Chaoxin, Wanfang, CQVIP, Springer-link, Science Direct, and Pubmed. Papers in Chinese were translated by dual lingual TCM and Western medicine doctors. Based on the identified studies, TCM is a safe additive treatment to Western medicine that can improve both symptoms and quality of life for patients with asthma.
Sources, distribution, bioavailability, toxicity, and risk assessment of heavy metal(loid)s in complementary medicines
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The last few decades have seen the rise of alternative medical approaches including the use of herbal supplements, natural products, and traditional medicines, which are collectively known as ‘Complementary medicines’. However, there are increasing concerns on the safety and health benefits of these medicines. One of the main hazards with the use of complementary medicines is the presence of heavy metal(loid)s such as arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg). This review deals with the characteristics of complementary medicines in terms of heavy metal(loid)s sources, distribution, bioavailability, toxicity, and human risk assessment. The heavy metal(loid)s in these medicines are derived from uptake by medicinal plants, cross-contamination during processing, and therapeutic input of metal(loid)s. This paper discusses the distribution of heavy metal(loid)s in these medicines, in terms of their nature, concentration, and speciation. The importance of determining bioavailability towards human health risk assessment was emphasized by the need to estimate daily intake of heavy metal(loid)s in complementary medicines. The review ends with selected case studies of heavy metal(loid) toxicity from complementary medicines with specific reference to As, Cd, Pb, and Hg. The future research opportunities mentioned in the conclusion of review will help researchers to explore new avenues, methodologies, and approaches to the issue of heavy metal(loid)s in complementary medicines, thereby generating new regulations and proposing fresh approach towards safe use of these medicines.
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Aspects for long-term culture and maintenance of an important South African medicinal plant cultured in vitro are discussed. The organogenic potential of Harpagophytum procumbens callus culture was investigated. Callus-derived shoots were highly vitrified and of insufficient viability after their immediate development. Subcultivation of shoots, separated from the callus, improved their vitality and resilience. Addition of silicon diminished shoot-tip necrosis, improved growth of leaves and shoots, and the solidity of roots at their bases. Appropriate rotation of culture media enabled a successful long-term culture of this plant in vitro.

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Review ArticleChinese herbal medicines revisited: a Hong Kong perspective

Summary

J Neurol Sci

Lancet

Lancet

Medicinal plants in China

A study on the practice of self-medication in Hong Kong

Hong Kong Practitioner

Hospital admissions due to adverse reactions to Chinese herbal medicines

J Trop Med Hyg

Adverse reactions to herbal and other unorthodox medicines

Toxicological outlook on the quality assurance of herbal remedies

Cardiotoxicity after accidental herb-induced aconite poisoning

Lancet

Aconitine poisoning following the ingestion of Chinese herbal medicines: a report of eight cases

Aust N Z J Med

Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs

Lancet

Poisoning by Chinese herbs

J Hong Kong Med Assoc

Review Article
Chinese herbal medicines revisited: a Hong Kong perspective